Development and validation of the Exercise-Induced Laryngeal Obstruction Dyspnea Index (EILODI)


Exercise-induced laryngeal obstruction (EILO) causes exertional dyspnea and is important
for its effect on quality of life, diagnostic confusion with exercise-induced asthma,
and health care resource utilization. There is no validated patient-reported outcome
measure specific to EILO.


We sought to develop, validate, and define a minimal clinically important difference
for a patient-reported outcome measure to be used with adolescents and young adults
with EILO.


A multidisciplinary group created a preliminary measure, modified by a 10-member participant
focus group, with 20 items scored along a 5-point Likert scale. A subsequent cohort
of participants recruited from a clinic, aged 12 to 21 years, with confirmed EILO
by continuous laryngoscopy during exercise testing (1) completed the measure at 3
points in time over 28 days and (2) provided anchoring data in the form of a daily
exercise log and categorical self-assessments of clinical improvement. Thirty additional
participants without exertional dyspnea served as controls.


Two hundred nineteen subjects with mild to severe EILO participated in the exploratory
factor analysis, which identified 7 factors within the preliminary outcome measure.
After a process of item reduction, a 12-item metric with a total score ranging from
0 to 48 was developed. Mean scores of patients with EILO and healthy controls at baseline
were 28.8 ± 7.4 and 4.5 ± 7.4, respectively. A minimal clinically important difference
of 6 was determined by comparison of index change with changes in categorical self-assessments
of improvement.


This is the first patient-reported outcome measure specifically designed for adolescents
and young adults with EILO.

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